In a 2014 national survey of 892 women with private insurance, the percentage paying $0 for contraception rose from 15% to 67% since 2012. The fees were similar for injection, vaginal ring, and IUDs. The price of pills likewise dropped substantially:

Cost of implementing rapid HIV testing in STD clinics

Clinics can avoid spending limited clinic resources yet still increase the number of persons identified as HIV-infected. Using data from 7 public clinics participating in a randomized trial of rapid HIV testing, Eggman et al., compared the cost of that testing with and without counseling. The researchers found that universal rapid testing can be implemented at low cost if risk reduction counseling is not offered:

Prevalence of Chlamydia trachomatis infection among women

Chlamydia is the most frequently reported STD in the United States, with a prevalence of 1.8 million infections reported from the NHANES survey. The risk for infection is associated with age, race/ethnicity, income, education, and number of sexual partners.

HPV vaccine effective in women older than 25

In a recent multinational double-blind randomized controlled trial of 2,264 subjects receiving HPV vaccine and 2,241 controls, the efficacy against persistent infection or CIN1+ with HPV was significant:

26-35 years of age: 83.5% efficacy

36-45 years of age: 77.2% efficacy

Among women who tested negative for DNA at baseline, the vaccine efficacy was similar for both seronegative and seropositive women. Rahman et al., calculate that the number of HPV infections prevented for every 100,000 women-years was 720 among women ages 26-35 and 364 among women 36-45.

61% fewer HPV cases following vaccine program in Australia

Ever wonder how many fewer women could develop HPV infection if more girls in the United States received vaccine? Australia has a model vaccine program with high distribution. Harrison et al., analyzed 1 million patient encounters between 2000 and 2012. After the program began, the rate of genital warts among women aged 15-27 years dropped to 1.67 cases per 1,000 patient encounters, which represents a 61% drop from the 4.33 cases/1,000 encounters prior to the program. Over this period of time, no other STDs showed a significant decline, so the drop in HPV infection was unlikely due to changes in sexual behaviors.

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This month’s clinical pearl

December 2018 Clinical Fact:

“Because implants and IUDs are highly effective, they are excellent choices for the short-term, too, and the fact that an implant or an IUD is good for “up to” 3 to 20 years is an added advantage but not always relevant.” — Contraceptive Technology, 21st edition